The World Bank pioneered global HIV and AIDS financing early in the emergency and remains committed to achieving Millennium Development Goal 6, to halt by 2015 and begin to reverse the spread of HIV and AIDS, through prevention, care, treatment, and mitigation services for those affected by HIV and AIDS.
Read More »

The overall outcome rating of the
HIV/AIDS Prevention Project for Vietnam was judged to be
moderately satisfactory. The Bank performance was
satisfactory and the borrower... Show More + performance ratings were
moderately satisfactory. The risk to development outcome
was substantial. Significant changes included revision and
expansion of the following components: implementation of
provincial HIV/AIDS action plans; National HIV/AIDS policy
and program; and project management. Other significant
changes were project closing date, which was extended twice,
and procurement category allocations. Several lessons were
learned. HIV prevention interventions need to be aligned
(and re-aligned) with changing epidemic trends. The
experiences of more than a decade of HIV prevention programs
in Vietnam indicate that a supportive legal and policy
environment is essential for the effective implementation of
harm reduction programs. To make harm reduction work,
sustainable commodity distribution models and channels are
needed. Social marketing may increase condom distribution to
Female Sex Worker (FSW). The targeting of venues where sex
work occurs was prioritized at the provincial level as a way
to increase condom availability. The development of programs
which increase condom use in an environment where sex work
remains illegal has required multi-sectoral collaborations
which have been driven by the Provincial AIDS Committee.
Condom promotion programs may not work as well as is
commonly accepted. Consistent with numerous other
international settings, the Needle and Syringe Program in
Vietnam has been shown to be cost effective. However, condom
distribution programs for FSW have only shown moderate
impacts on high-risk sexual behaviors and HIV prevalence.
There is not strong evidence of epidemiological impact
associated with condom distribution programs. Show Less -

Ratings for the Second Population and
AIDS Project for Chad were as follows: outcomes were
moderately unsatisfactory; risk to development outcome was
substantial; Bank... Show More + performance was moderately unsatisfactory
and borrower performance was also moderately satisfactory.
Some lessons learned includes: while the Bank can be
instrumental in stimulating Government commitment for both
HIV/AIDS and population, commitment is perhaps more easily
sustained for HIV/AIDS than for population. The advantages
and disadvantages of building on previous projects need to
be carefully examined during project preparation. While the
introduction of the mobile health teams and the Result-based
Financing (RBF) contradicted this lesson, this was justified
by the fact that when the existing delivery of services is
so poor and the need for services so great, important risks
are warranted, even without adequate feasibility studies.
For the follow-on project, more 'due diligence' is
in progress to assess accurately the risks of the operation
with a view to build stronger government ownership. The
importance of efficiency as a criterion for assessing health
and social development projects must be seen in a broader
context. There is no substitute for timely baseline data and
an operational Monitoring and Evaluation (M&E) system. Show Less -

Ratings for the Second HIV/AIDS Project
for Jamaica were as follows: outcomes were moderately
satisfactory, the risk to development outcome was
substantial, the Bank... Show More + performance was moderately
satisfactory, and the Borrower performance was also
moderately satisfactory. Some lessons learned included:
behavior change takes time, particularly in countries like
Jamaica with complex socio-cultural environments.
Consequently, it is important that the anticipated outcomes
recognize and take into account: (a) the time lag between
activities and results; (b) the potential challenges in
setting and achieving Project targets; (c) the inputs and
strategies needed to effect change; and (d) importantly,
emerging options such as the use of treatment as prevention.
During project preparation, the overall environment for
procurement should be assessed, and the design of
procurement arrangements should balance transparency and
accountability with effective implementation. For instance,
higher thresholds for requiring competitive bidding should
be considered, along with some relaxation or flexibility of
the need to obtain three quotations under the shopping
method should be considered. This is particularly critical
in small island states like Jamaica with limited numbers of
local vendors, and small quantities, which make bidding
unattractive to external vendors. In addition, the weak
capacity, particularly in procurement could have been
addressed through more hand holding and training to prevent
some delays. Show Less -

Ratings for the Emergency Multi-Sector
HIV/AlDS Project for Cote d'Ivoire were as follows:
outcomes were moderately satisfactory; risk to development
outcome was moderate;... Show More + Bank performance was moderately
satisfactory; and borrower performance was also moderately
satisfactory. Some lessons learned includes: sustained
political commitment at higher levels, together with the
allocation of domestic resources, is essential to mobilize
and effectively engage development partners in conflict
prone settings like Cote d'Ivoire. Rapid project
implementation was assisted by taking advantage of the
project preparation period to identify key implementation
requirements and initiate required activities such as
recruitment of implementing agencies, procurement of goods.
Close monitoring of the project toward the achievement of
project development objectives using a simplified and
well-designed Monitoring and Evaluation (M&E) system is
essential. This will help for regular monitoring of progress
and analysis of implementation challenges for timely
implementation of corrective measures. The use of local
Non-Governmental Organization's (NGO's) to deliver
HIV/AIDS prevention services was commendable. This service
delivery modality could be applied to the provision of other
services, especially for client groups where the use of
public service providers is problematic. In the context of
post conflict and fragile situation where large parts of the
population are prone to displacement and economic
precariousness, the usual landscape of commercial sex work changes. Show Less -

Ratings for the Human Immunodeficiency
Virus Infection / Acquired Immunode Ficiency Syndrome
(HIV/AIDS) Prevention Project for Afghanistan were as
follows: outcomes... Show More + were moderately satisfactory; risk to
development outcome was substantial; bank performance was
moderately satisfactory; borrower performance was moderately
satisfactory. Some lessons learned included: preparation and
effective implementation of an HIV/AIDS project in
Afghanistan demonstrated that innovative programming is
possible even in situations of extreme fragility and low
counterpart capacity; the use of Non-Government Organization
(NGO) contracting for service delivery, although challenged
by delays in defining and implementing a selection process
in a limited field of potential candidates, built on solid
experience in this innovative approach and helped form the
model for future projects; the efficiency of HIV prevention
programs is greatly enhanced by the generation of
epidemiological data to guide allocations to those
populations and regions at greatest risk; the effectiveness
of HIV prevention programs depends on technical strength of
evidence-based interventions, adequate coverage of target
populations with services and a permissive legal and policy
framework; and the World Bank has been a global leader in
providing services to vulnerable and marginalized
populations in the HIV epidemic. Show Less -

Ratings for the Multi-Donor Trust Fund
Human Immunodeficiency Virus/ Acquired Immune Deficiency
Syndrome (HIV/AIDS) Project for South Sudan were as follows:
outcomes... Show More + were moderately unsatisfactory; risk to development
outcome was significant; bank performance was moderately
satisfactory; and borrower performance was moderately
satisfactory. International Non-government Organization
(NGOs) might be faster in service delivery but not
sustainable over the long term; engage early on capacity
building and use other avenues and partners to reach goals;
realistic results-based indicators are essential at the
outset; undue emphasis on inter-sectorial action on HIV/AIDS
should be avoided in low capacity systems. Show Less -

Ratings for the Second Multisectoral
Human Immunodeficiency Virus (HIV) or Acquired
Immunodeficiency Syndrome (AIDS) Control Project for Benin
were as follows: outcomes... Show More + were satisfactory, risk to
development outcome was moderate, Bank performance was
satisfactory, and Borrower performance was moderately
satisfactory. Some lessons learned included: survey
techniques such as Lot Quality Assurance Sampling (LQAS)
should be planned, financed, and carried out under the
project to monitor indicators based on household data. It is
crucial to express effectiveness conditions in precise terms
in order to avoid loopholes that can jeopardize project
implementation. Having a thorough understanding of HIV or
AIDS epidemic dynamics by population group and geographic
areas is a mandatory pre-requirement to design programs and
invest resources where they can achieve the highest impact.
The selection of indicators in the results framework needs
to be aligned with the likely major contribution made by the
Bank resources, following the results chain. Using a
fiduciary agency to manage the subproject component can be
the key to successful implementation as it leaves the
Project Implementation Unit (PIU) free to concentrate on
coordination instead of getting involved in a field for
which it does not have a comparative advantage. Using a
fiduciary agency, like Agence de Gestion Fiduciaire du Benin
(AGeFIB), to run the financial management of simultaneous
funding of community-based organizations increases operation
efficiency where community level action is required.
Allocation of roles and responsibilities should be defined
precisely upfront. Using local councils to work with
Non-Governmental Organizations (NGOs) and to be responsible
for implementing and coordinating the Monitoring and
Evaluation (M and E) system at the decentralized level can
be a key to success by producing needed data in a timely and
efficient manner. Show Less -

Ratings for the Multi-Sectoral Human
Immunodeficiency Virus (HIV) and Acquired Immune Deficiency
Syndrome (AIDS) Project (MAP) for Malawi were as follows:
outcomes were... Show More + moderately satisfactory, risk to development
outcome was high, Bank performance was satisfactory, and
Borrower performance was satisfactory. Some lessons learned
included: a sector-wide approach to HIV or AIDS can help a
country with a generalized epidemic achieve positive
results, efficiently. This is achieved through (i) reducing
the administrative burden on the coordinating body (NAC)
through joint work programming, accounting, and reporting
systems; (ii) enabling the coordinating body to develop a
strategic, integrated approach to coordinating the national
response; and (iii) building local ownership of the national
program as a whole. Pooled funding mechanisms are an
efficient tool to support HIV national strategic plan.
Government ownership and setting up proper functional
institutional arrangements is critical to achieving results.
There are benefits of centralized procurement for common
items and high value capital goods in addressing capacity
constraints of sub-grantees. Show Less -

Ratings for the Third National human
immunodeficiency virus (HIV) and acquired immune deficiency
syndrome (AIDS) Control Project for India were as follows:
outcomes... Show More + were satisfactory, risk to development outcome was
low, Bank performance was satisfactory, and Borrower
performance was satisfactory. Some lessons learned include:
business management principles can be applied successfully
to HIV prevention interventions for sex workers, men who
have sex with men (MSM), and injecting drug users (IDUs)
when they are regarded as clients to whom services need to
be marketed and delivered, with rigorous attention to
results, quality, and efficiency, and detailed monitoring
using a management information system in which data are
collected routinely and used to guide decisions, adjust
operating procedures, and propagate good practice.
Prevention can be effective when a tailored localized HIV
response relies on trusted community-based organizations
(CBOs) and nongovernmental organizations (NGOs) as
front-line implementers. Detailed procedural and protocol
manuals, guidelines, and standards-backed with regular
training, with periodic review and updating to reflect best
practice-can greatly enhance the efficiency and quality of
program implementation. Developing a computerized management
system, and investment in on-site long-term technical
information technology (IT) support can have a strong
pay-off in debugging the system in its initial stages, and
then in seeking ways to improve and enhance the system to
take advantage of changing technology and to continuously
look for ways it can better support management decisions.
Country- and context-specific judgment is needed in deciding
which safeguard policies should usefully apply, instead of
bureaucratic box-ticking compliance that uses scarce time
and other resources without adding value or gains for
intended beneficiaries. Roles and responsibilities need to
be clearly defined so that this does not slip between two
stools of procurement and financial management units in an
implementing agency. Show Less -

Ratings for the HIV/AIDS and Health
Project for the Republic of Congo were as follows: overall
outcome was moderately satisfactory, the risk to development
outcome was... Show More + modest, the Banks performance was satisfactory,
and the Borrower performance was moderately satisfactory.
Over the past decade, the Government of Congo has
systematically promoted appropriate institutional
arrangements and participatory mechanism for testing, care,
treatment, education, counseling and reducing discrimination
against those affected by the virus. Concerns, however,
about the financial future and sustainability on the
national response level remain. The Congo HIV/AIDS and
Health Project was characterized by delays in planning,
budgeting, and effectiveness in implementation of the
Project. Lessons learned from the implementation of the
HIV/AIDS and Health Project include: (A) Strong political
commitment is critical to establishing an enabling
environment to address the HIV/AIDS challenge in
post-conflict situations. (B) Strengthening management
capacity and promoting innovation are essential to achieve
results in low-capacity post-conflict environments. (C)
Ensuring the evidence basis for and the appropriateness of
indicators of project achievement is key to HIV/AIDS program
management. Overall, the Project has made it possible to
establish the basis of the national response to the fight
against HIV/AIDS in Congo through its contribution to
financing of the various strategic frameworks. Show Less -

Ratings for the Multisectoral HIV/AIDS,
Health, and Education Emergency Support Project for Central
African Republic (CAR) were as follows: outcomes were
moderately... Show More + satisfactory; risk to development outcome was
moderate; Bank performance was moderately satisfactory; and
borrower performance was also moderately satisfactory. Some
lessons learned includes: strong ownership and the
commitment of key actors could leverage significant funding
and ensure continuity in the government and partner efforts
even under circumstances that do not allow for normal
operation. The case of CAR demonstrated this in two ways.
First, the project faced more than five years of suspension
before effectiveness but the government was still able to
make full use of project advances and Trust Funds that were
exceptionally granted to strengthen its institutional
capacity, and as a result, leveraged large amount of
resources from different partners. Second, once the decision
on re-engagement was made, the World Bank team and the
government moved swiftly with the project preparation
capitalizing on what had been built in the preceding years,
while adjusting the design and implementation mechanism to
meet the actual needs. A strategy shift in 2007 from a
single HIV/AIDS operation to a multifaceted one encompassing
broader social sectors promoted a higher response to needs
in diverse areas. In addition, synergies were created to
ensure efficient use of resources. A clear, well-defined
institutional arrangement from the outset is crucial to
achieving optimal results in a multisectoral operation.
Stakeholders agreed that part of the initial implementation
delays were caused by ambiguity in their division of roles
and responsibilities, given the complexity of the project
set-up and the numerous parties involved. Some of
project's creative approaches for fiduciary
arrangements could provide important lessons in a context of
political instability and post-conflict situations. Use of
Civil-Society Organizations (CSOs) needs to be accompanied
by a realistic capacity assessment and support for capacity
strengthening. The project underscored the great benefits of
civil society involvement and empowerment of communities in
responding to their own needs and reaching out to the most
remote areas; however, adequate technical capacity of these
organizations needs to be ensured. Show Less -

Ratings for the AIDS Control Project for
Central Asia were as follows: outcomes were moderately
unsatisfactory, the risk to development outcome was
significant, the... Show More + Bank performance was moderately
unsatisfactory, and the Borrower performance was also
moderately unsatisfactory. Some lessons learned included: a
regional HIV/AIDS strategy will provide the strategic
framework for a regional HIV/AIDS project to support. For
this reason, ideally, a regional HIV/AIDS strategy should
have been formulated during project preparation or at least
during the early phase of project effectiveness to guide the
project implementation. Unfortunately, the regional HIV/AIDS
strategy was not developed and adopted until October 2009,
which was one year after Mid-Term Review (MTR). Risks
potentially compromising implementation, including political
economy, institutional/implementation arrangements, and
fiduciary risks should be realistically assessed and
properly mitigated at the outset. This is even more crucial
for novel and complex projects facing challenging
environments with new institutions and various conflicting
interests. Although the project in many respects was
exemplary in its inherent relevance to Bank policies and
country strategies, it proved once again the need for: (i)
objectives and performance indicators to be carefully
selected; (ii) an adequately designed monitoring and
evaluation (M&E) system to be in place at the start of
implementation; and (iii) appropriate arrangements to be in
place to ensure that information is used strategically for
decision making. The risks associated with this project were
underestimated at appraisal. The right composition of a task
team, including specialized public health and
epidemiological skills for HIV/AIDS projects and strong
operational skills, is required to supervise complex
projects in challenging environments. Such skills should be
a key feature identified during project preparation and
presented in supervision plans. Show Less -

Ratings for the Second Multi-Sectoral
HIV/AIDS Project for Ethiopia were as follows: outcomes were
satisfactory, the risk to development outcome was high, the
Bank performance... Show More + was moderately satisfactory, and the
Borrower performance was also moderately satisfactory. Some
lessons learned included: the establishment and
strengthening of HAPCOs (HIV/AIDS Prevention and Control
Office) at the federal, regional and woreda levels was a
major undertaking that has proven effective. The time,
staffing and other resources allotted for the continued
strengthening of the system are important in project
implementation. The project supported effective coordination
of an impressively wide range of public sector agencies.
Particular care is needed to ensure that the levels of
capacity are sufficient to manage large influxes of donor
funding; in the absence of this, smaller projects are likely
to receive insufficient attention. Availability of the
country based Task Team Leader (TTL) is critical for ongoing
supervision of the project and timely identification of
bottlenecks and appropriate solutions. Such a framework
needs to reflect the different Monitoring and Evaluation
(M&E) requirements and approaches to capacity building
of different partners, and to ensure timely integration of
different components of the system; in the case of project,
delays in establishment of the Community Information System
(CIS), and in integrating the Health Management Information
System (HMIS) and HIV/AIDS systems, led to lack of timely
information to report on program performance. The project
design underestimated the level of inputs and time which
will be needed to have an effectively functioning and fully
integrated system. The Epidemiological Synthesis study,
carried out with Bank support in 2008, was an important
contribution to national program development and updating,
and confirmed the importance of focusing on prevention and
targeting the most-atrisk population and hot spot areas, but
continued follow up was (and still is) required for a fully
effective response. A later survey15 identifying Institutes
of higher learning as emerging hot spots? for HIV
transmission and identified university students as a
previously unrecognized group at risk of acquiring HIV infection. Show Less -

Ratings for the HIV/AIDS and Sexually
Transmitted Infections (STI) Prevention and Control Project
for Bhutan were as follows: outcomes were moderately
unsatisfactory,... Show More + the risk to development outcome was
substantial, the Bank performance was moderately
unsatisfactory, and the Borrower performance was also
moderately unsatisfactory. Some lessons learned included: in
the absence of any kind of strategic plan for HIV/AIDS, as
was the case in Bhutan, project preparation should include
support for the development of such a plan prior to
appraisal. The plan will then form the basis for project
design and reinforce the 'Three Ones' principles
in HIV/AIDS response. It will also help engage all
stakeholders and build stronger commitment. In a low
prevalence setting with severe human resources constraints,
such as Bhutan, the best use of resources (human and
financial) is to focus on HIV/AIDS interventions for
most-at-risk populations (MARPs). It is critical to
undertake behavioral surveillance and socio-geographical
mapping of MARPs prior to designing policies and program
interventions. This will also provide baseline data for the
Results Framework and helps set realistic targets. In
addition, STI patients should be viewed as a MARP and
benefit from Behavioral Change Communications (BCC) and
Voluntary Counseling and Testing (VCT) other than STI
treatment. Public actors are less effective and motivated to
conduct outreach for marginalized MARPS such as Commercial
Sex Worker (CSW), injecting drug use (IDU) and sex with men
(MSM). Peer groups should be mobilized for this purpose.
While the multi-sectoral approach can be relevant for a low
prevalence country; activities should be restricted to the
most critical sectors given severe human resource
constraints, such as in Bhutan. Such a streamlined
multi-sectoral design will facilitate implementation.
Monitoring and Evaluation (M&E) should be tailored to
the country's limited capacity and characteristics of
the epidemic. Information should be used to improve the
evidence base for local decision making. Show Less -

Ratings for the HIV/AIDS, Malaria and
Tuberculosis Control (HAMSET) Project for Angola were as
follows: outcomes were moderately satisfactory; risk to
development outcome... Show More + was moderate; Bank performance was
moderately satisfactory; borrower performance was also
moderately satisfactory. Some lessons learned include:
capacity building for results: the lack of capacity in
Angola during the period of project implementation needs to
be recognized and a review of performance and results
achieved needs to take this firmly into account.
Implementation arrangements: the establishment of a PCU in
the Ministry of Health (MoH), and not the National AIDS
Council Multi - Sectoral AIDS project (as with other MAP
projects) was positive and relevant at the time. It allowed
the Project Coordinating Unit (PCU) to develop strong links
with each of the three disease programs. Integration and
efficiency: looking ahead Angola should focus more on
integration of disease specific programs and do more to
address system wide constraints. Also further attention
should be given to the efficiency and cost effectiveness of
services delivered, to maximize value for money.
Geographical targeting: any geographical targeting of most
in need populations by the project should be documented and
accompanied by a clear rationale. Flexibility but with a
focus on desired results: the project provided a good degree
of flexibility to respond to the rapidly evolving needs and
also provided support to fill critical gaps in the national
plans. However in supporting new activities the project gave
up and missed opportunities to fund some critical
interventions (in the original plans) which would have
provided a more direct contribution to the projects desired
results. (M and E) Monitoring and Evaluation. The Angolan
context requires that special attention and support be given
in all projects to M and E, especially to establish the
baseline and end line data for the project. Show Less -

Ratings for the HIV/AIDS Response
Project for Mozambique were as follows: outcomes were
moderately satisfactory, the risk to development outcome was
substantial, the... Show More + Bank performance was moderately
satisfactory, and the Borrower performance was also
moderately satisfactory. Some lessons learned included:
while a strictly technical public health approach would
direct resources from the start towards targeting
interventions to geographic areas and population groups with
the highest HIV prevalence, that direction may from a longer
term perspective not always be the right one. Money came to
the Mozambican communities because of AIDS. As a result,
communities organized themselves. They were empowered to
begin to take control of their lives. The income generating
activities assisted vulnerable groups to better cope with
their vulnerability, and demonstrated that a small amount of
money could go a long way. They focused on the enormous and
immediate needs of orphans and vulnerable children. These
impact mitigation efforts opened the door for an open
dialogue in the communities on the risks for HIV infection
and laid the foundation for a community-based approach to
prevention. Active involvement of civil society means that
one must be prepared to finance its priorities, even if
these are not immediately and evidently perceived as the
most cost-effective to curb the epidemic. The Bank responded
swiftly and appropriately to addressing the HIV/AIDS
situation in Mozambique when there were few development
partners on the ground and limited financing. The fact that
the basic design of the project could be maintained through
five amendments to the Development Grant Agreement (DGA)
proves that the Multi-country AIDS Program (MAP) instrument
was used in a flexible way and could respond to the
country's evolving needs as the national strategy
developed and new partners came on board. Show Less -

Ratings for the Second Multisectoral
HIV/AIDS Project for Burundi were as follows: outcomes were
moderately satisfactory; risk to development outcome was
moderate; Bank... Show More + performance was moderately satisfactory and
borrower performance was also moderately satisfactory. Some
lessons learned includes: the Results-Based Financing (RBF)
scheme is a suitable tool to accelerate and/or maintain the
achievement of results even within weak health systems like
the one in a post-conflict country. The scaling up of the
RBF scheme at country level can contribute significantly to
achieving significant results in a relatively short period
of time. Close coordination and collaboration between
partners is necessary to ensure sustainability of achieved
results. Project task team need to correct any discrepancy
between the Project Appraisal Document (PAD) and the
financing agreement to harmonize the language between the
two important reference documents. Show Less -

Ratings for the Multisectoral HIV/AIDS
Project (MAP) for Democratic Republic of Congo were as
follows: outcomes were unsatisfactory; risk to development
outcome was... Show More + substantial; Bank performance was
unsatisfactory; borrower performance was also
unsatisfactory. Some lessons learned includes: lack of
realism and phasing in a project design and implementation
in a conflict or post-conflict country can undermine the
project ability to achieve its development objectives. This
project undertook to cover the entire country after a
conflict which left the country with weak institutional
systems. Identification of some hotspots along with
concentrating efforts in limited number of easily accessible
provinces may have increased the chance of the project to
achieve its development objectives. In a post-conflict
country, swift and frequent restructuring exercises may be
necessary in order to adapt the project design and
implementation as the situation changes and new data become
available. Strict adherence to global project frameworks can
undermine undertaking necessary adjustments to adapt a
project to the specific situation of a particular country.
Frameworks such as MAP, Avian Influenza, and food crisis
present the advantage that once the Board has approve the
framework, then it become easy to expedite project. In a
country with particularly weak capacity, it is imperative to
have a Task Team Leader (TTL) in the field at the onset of
the project and avoid frequent TTL changes. It takes at
least one full year for a TTL to better understand a project
in depth and therefore an additional couple of years at
least are needed to ensure continuity and smooth
implementation of the project. Similarly, in weak capacity
environments, the Bank needs to exercise intense fiduciary
oversight even when international firms have been hired to
provide fiduciary services. Donor driven projects from the
beginning to the end without proper incremental integration
into the Government budget processes poses a substantial
risk to the sustainability of development outcomes. Show Less -

Ratings for the HIV/AIDS Prevention and
Control Project for St. Vincent and the Grenadines (SVG)
were as follows: outcomes were moderately satisfactory; risk
to development... Show More + outcome was low; Bank performance was
moderately satisfactory; and borrower's performance was
also moderately satisfactory. Some lessons include:
selective targeting of implementing agencies. The project
design clearly identified implementing agencies and assigned
specific tasks to each one, resulting in a clear
implementation plan. Such a design had been shown to work
well in other similar projects, namely in Saint Lucia and
Guyana. Selecting key, measurable indicators. The country
would also benefit from a more focused and shorter list of
indicators that need to be tracked. While SVG has been
generally able to report on key indicators, other countries
with weak Monitoring and Evaluation (M and E) capacity and
culture often have difficulties in collecting large sets of
data, which may in fact hinder progress. Supporting broader
health systems strengthening. SVG's Health Management
Information System (HMIS), financed through this Project,
has a broader impact beyond HIV/AIDS. Transitioning staff
for sustainability. Within the Government infrastructure,
the ability to retain technical staff after project closure
is a necessary requirement to guarantee operational
sustainability, as well as to solidify the gains achieved
under the project. Show Less -

Ratings for the Multi-Sectoral AIDS
Project (MAP) for Guinea were as follows: outcomes were
moderately satisfactory, the risk to development outcome was
substantial,... Show More + the Bank performance was moderately
satisfactory, and the Borrower performance was also
moderately satisfactory. Some lessons learned included:
Guinea offers an example of where program advances in the
fight against HIV/AIDS can occur even where political
instability and political leadership (both of which are
usually assumed to be prerequisites) are not entirely
adequate. To a large extent this was due to the
project's ability to find champions among those groups
who were committed. To a large extent this was due to the
project's ability to find champions among those groups
who were committed. In Guinea, these groups were found
among: (i) the public sector (especially, some of the
'second tier' ministries and local authorities at
regional and prefectoral levels); (ii) the private sector
(particularly the mining sector and several labor unions);
and (iii) communities. Eventually, these private sector and
community-level initiatives were able to overcome (at least
to a certain extent) uneven government commitment and weak
capacity. Guinea demonstrates that insufficient attention is
paid during project implementation to the risks and risk
mitigation measures proposed in theproject appraisal
document (PAD). In the case of the Guinea MAP, three of the
four output to objective risks were correctly identified
(though perhaps incorrectly rated), but the measures proved
to be wholly inadequate to alter the situation. While
project preparation cannot be expected to pre-identify all
of the potential solutions to problems which might arise,
supervision missions should be required to link their
recommendations at least in part to the risks so as to track
the effectiveness of the mitigation measures for future
projects. This will seem to be the Bank's counterpoint
to 'learning by doing.' Show Less -